Commentary: Easing restrictions can help solve America’s doctor shortage

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Sally C. Pipes

Doctor’s appointments will be hard to come by over the next decade, according to new data from the Association of American Medical Colleges. By 2036, the organization estimates, the United States will be short as many as 86,000 physicians.

This is a shortage of not just doctors but medical care. In most sectors of the economy, shortages tell suppliers it’s time to boost production. But government regulation has artificially restricted the supply of medical care for years.

We must relax those regulations in order to boost the supply of medical care — and meet the needs of patients.

There are plenty of medical professionals who can help address this shortage of medical care — if only they’re allowed to. Nurse practitioners and physician assistants go through years of training and clinical practice to get qualified. They can diagnose and treat patients, and prescribe medication. Right now, there are about 280,000 nurse practitioners and 126,000 physician assistants in the United States.

In many areas, “scope of practice” laws prevent these professionals from practicing to the full extent of their training. Nearly half the states have laws limiting nurse practitioners’ ability to practice. Proponents of these rules argue that allowing nurse practitioners and physician assistants to practice without restrictions would put patients at risk. Yet research shows otherwise.

A study by researchers at New York University and Boston College concluded that “(s)tate regulations restricting (nurse practitioner scope of practice) do not improve the quality of care.” A study from the University of Central Florida found that broadening nurses’ scope of practice may actually improve quality of care. And according to a 2023 study from the University of Alabama School of Law, over a 14-year period, expanding scope of practice for nurse practitioners and physician assistants reduced healthcare-related deaths — by 12 per per,000 people and 10 per 100,000 people, respectively. Rural areas, which tend to have the biggest primary-care shortages, saw even greater improvements. It’s clearly time for states to get rid of scope-of-practice rules.

Another way to expand the supply of medical care is to make it easier for international medical graduates to practice in the United States.

Research shows that physicians with degrees from international medical schools provide high-quality care. According to a study published in the BMJ, Medicare patients tended to by internationally trained internists had lower mortality than patients treated by U.S. medical graduates.

Physicians who obtain their degrees abroad often face stiff requirements to get U.S. medical licenses. First, they have to complete two or three years of graduate medical education in the United States. Then they have to take the U.S. Medical Licensing Examination, apply for a residency, and obtain a state medical license. The process can take years. It’s no wonder some doctors who move to America pursue careers in other fields. A recent survey of nearly 300 immigrant doctors disclosed that two out of three with jobs weren’t working as physicians.

Tennessee recently eliminated the requirement that all international graduates complete U.S. residencies. Other states should consider following suit.

Demand for medical care will only increase in the years to come, as the U.S. population ages. Meeting that demand will require eliminating the regulations that have long curtailed the supply of care.

Sally C. Pipes is president, CEO and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute in San Francisco.